Tonsillitis and sudden childhood death

Critical reduction in upper airway diameter may result from tonsillar enlargement due to infection or from associated abscess formation. Other potentially lethal complications include hemorrhage and disseminated sepsis. Two cases are reported to illustrate features of specific cases: Case 1: a 12-year-old girl who exsanguinated from a pharyngocarotid fistula caused by a retropharyngeal abscess due to acute tonsillitis, and Case 2: a 17-year-old girl who asphyxiated from an aspirated blood clot following tonsillectomy. While most cases of acute tonsillitis resolve without sequelae, occasional cases may be associated with a lethal outcome. Massive hemorrhage may occur due to erosion of tonsillar vessels or subjacent larger vessels, or it may follow surgical extirpation of the tonsils. The autopsy assessment of cases where there has been possible lethal tonsillar pathology requires review of the presenting history and possible operative procedures, with careful dissection of Waldeyer's ring, adjacent soft tissues and major vessels. Presentations may not be straightforward and there may be misleading histories of epistaxis, hemoptysis, hematemesis and even melena.